Obesity – can we change hearts, minds and waistbands?

Lord Tebbit, possibly the most charming member of the House of Lords, this week, said that obese people “ought to know that if they stuff themselves silly with high-calorie, rubbish foods they will get fat”. He derided obesity help forums as “nonsense”, and “merely trying to divorce people from the consequences of their own stupid actions”. Health Minister Earl Howe agreed with him. For those that may have forgotten, Lord Tebbit is well known for his sensitivity and thoughtfulness; he contributed to the Equal Marriage debate by saying he would support the measure because it would allow him to marry his own son, thus avoiding inheritance tax.

We are now in National Obesity Awareness Week, so Lord Tebbit’s comments are particularly prescient. A quarter of men and women are now classed as obese, and the National Obesity Forum are expecting more than 50% of the UK will be obese by 2050. Worldwide, obesity has more than doubled since 1980.

Obesity is a complex problem that cannot just be addressed with the overly simplistic “eat less, exercise more” mantra that is wheeled out across the media. Food is emotional, familial, and cultural; far more than just fuel.  In order to make a lasting impact on obesity levels, we need positive policies that change people’s environments and behaviours for good.

It is often overlooked in media reports on weight issues that social inequality is at the heart of the epidemic. The Public Health England report on social and economic inequalities in diet and physical activity published in November last year makes a strong, clear case for this. Access to quality and affordable food, exercise opportunities, and education are all lacking in areas of deprivation; these areas also have a high proportion of overweight and obese residents. And if social inequality is at the root of the cause of obesity, then Labour must respond.

Research from the same report states that people from lower economic backgrounds are proportionately affected by the rise in food costs.  Deprived areas have less access to parks, green space and safe play areas. And lower educational levels have a direct link with diet and physical activity; poorer people tend to eat less healthy diets and be less physically active than the people who are better off. The Low Income Diet and Nutrition Survey shows that those with no educational qualifications were less likely to eat fruit and vegetables and more likely to eat high energy dense foods than those with educational qualifications. And statistics show that among children in reception and year 6, obesity in the 10% most deprived groups is double that in the 10% least deprived.

The most deprived areas across the country also have the highest proportion of fast food outlets. Last year the Academy of Royal Medical Colleges published a report with ten recommendations for tackling obesity; regulating fast food shops close to schools, colleges and leisure centres was a key suggestion. St Helens Council implemented a 400 metre fast food exclusion zone around primary, secondary and sixth form colleges. Local authorities across the country could make a positive impact on the health of young people by doing the same.

But we also need to change our attitudes towards fat people. Bullying Tebbit style is counterproductive; obesity occurs for many reasons, not just because of too many trips to the chip shop. We also need to reassess how we determine what is a healthy size and what is not.  The BMI Index has been proven to be flawed, yet it is still used as a primary measure of “healthy” weight. I know this only too well; I was once a size 24. I am now an 18, a healthy eater with an active lifestyle and a clean bill of health. Yet I’m still classified as obese.  How can a 10 stone couch potato existing on takeaways be considered healthier than I, based solely on the BMI index? We need a more holistic approach to determining health.

We also need to examine issues around obesity, self esteem and mental health. Dr Linda Bacon, nutrition professor in the Biology Department at the City College of San Francisco is the originator of the Health at Every Size movement, and promotes self-acceptance, physical activity and normalised eating as a way to healthy living, no matter what size you are. I’d like to see the forward thinking Health at Every Size philosophy taught in every school. Alongside addressing issues around economic and educational inequalities and regulating fast food joints, we just might be able to change hearts, minds and waistbands.